As I’ve discussed, oh, once, twice, or maybe three times in the past, ankle or wrist sprains (or even buckle fractures) do NOT need a splint. Today’s article from JAMA Pediatrics echoes this sentiment.
We’ll keep this simple: 271 patients aged 5-12, with a clinically suspected Salter Harris Type one ankle fracture were approached, 140 parents consented to participate. All patients were initially placed with a removable brace (hooray!), then underwent bilateral ankle MRI imaging (?!?! boo!!!) one week later.
Of the 135 patients that underwent MRI imaging, 4 (3%) had MRI confirmed Salter Harris type 1 fractures, 2 of which had partial growth plate injuries. 108 (80%) pateitnts had ligamentious injuries and 27 (22%) patients had isolated bone contusions. 38 patients had radiographically occult fibular avulsion injuries.
Importantly, of those with MRI detected fractures, there was no difference in outcomes from those without fractures (82% vs 85.5% on the Activity scale for Kids score).
So… while you can certainly MRI these patients – and find things – the question is, if they are not clinically relevant, why do it in the first place?